rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2016-289-298rsp-2218Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHМиозит, ассоциированный со злокачественными опухолямиMYOSITIS ASSOCIATED WITH MALIGNANT TUMORSАнтелаваО. А.AntelavaO. A.

кафедра ревматологии Института профессионального образования,

119991 Москва, ул. Трубецкая, 8, стр. 2

Department of Rheumatology, Institute of Professional Education,

8, Trubetskaya St., Build. 2, Moscow 119991

antelavao@gmail.comХелковская-СергееваА. Н.Khelkovskaya-SergeevaA. N.

115522 Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

ЧичасоваН. В.ChichasovaN. V.

кафедра ревматологии Института профессионального образования,

119991 Москва, ул. Трубецкая, 8, стр. 2

Department of Rheumatology, Institute of Professional Education,

8, Trubetskaya St., Build. 2, Moscow 119991

Раденска-ЛоповокС. Г.Radenska-LopovokS. G.

115522 Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

ГлуховаС. И.GlukhovaS. I.

115522 Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава РоссииРоссияI.M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaRussian FederationФГБНУ Научно-исследовательский институт ревматологии им. В.А. НасоновойРоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation201619072016543289298Copyright © Антелава О.А., Хелковская-Сергеева А.Н., Чичасова Н.В., Раденска-Лоповок С.Г., Глухова С.И., 20162016Антелава О.А., Хелковская-Сергеева А.Н., Чичасова Н.В., Раденска-Лоповок С.Г., Глухова С.И.Antelava O.A., Khelkovskaya-Sergeeva A.N., Chichasova N.V., Radenska-Lopovok S.G., Glukhova S.I.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2218

Идиопатические воспалительные миопатии (ИВМ) – гетерогенная группа приобретенных системных заболеваний с преимущественным поражением скелетной мускулатуры. Основными представителями ИВМ являются полимиозит (ПМ) и дерматомиозит (ДМ). Эпидемиологические исследования демонстрируют взаимосвязь между ПМ/ДМ и злокачественными новообразованиями (ЗН), риск выявления которых выше, чем в популяции соответствующих возрастных групп. Частота ЗН при ПМ/ДМ колеблется в диапазоне от 9 до 50%. Связь со ЗН описана при каждом подтипе ИВМ, однако наиболее часто они выявляются при ДМ. Пациенты, страдающие ПМ/ДМ, ассоциированным со ЗН, имеют худший прогноз, чем больные ЗН. Раннее выявление ЗН позволило бы улучшить прогноз у этих больных. Опубликованные исследования выделяют демографические, клинические и лабораторные факторы, повышающие риск выявления ЗН у пациентов с ПМ/ДМ. Тем не менее все они охватывают небольшие группы больных, полученные результаты неоднородны и не вполне убедительны, что требует дальнейшего, более масштабного, изучения этой проблемы.

Цель исследования – выявление и идентификация особенностей паранеопластического миозита (ПнМ).

Материал и методы

Материал и методы. В исследование включены 320 пациентов с достоверным диагнозом ИВМ, наблюдавшихся за период с 1996 по 2016 г. Пациентам проводили лабораторное исследование, мануальное мышечное тестирование силы проксимальных мышц по 10-балльной шкале и электромиографическое исследование игольчатыми электродами.

Результаты и обсуждение

Результаты и обсуждение. ПнМ был выявлен у 32 (10%) из 320 больных ИВМ. Среди пациентов с ПнМ было 6 (19%) мужчин и 26 (81%) женщин. Средний возраст дебюта ПнМ составлял 55,4 года. Дебют клинической картины болезни был представлен характерным кожно-мышечным синдромом у 19 (59%) пациентов, у 18 (41%) из них ЗН обнаружено в течение первого года от начала болезни. У 13 (41%) больных манифестация ЗН предшествовала картине ПМ/ДМ. Наиболее часто выявляли рак яичников (37,5%), ЗН легкого и молочной железы (15%), далее следовали ЗН кишечника (12,5%), крови (6,3%), матки (6%) и желудка (3,1%). Медиана выживаемости больных с ПнМ составила 5 лет.

Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of acquired systemic diseases mainly involving skeletal muscles. The main representatives of IIM are polymyositis (PM) and dermatomyositis (DM). Epidemiological surveys demonstrate that there is a relationship between PM/DM and malignant neoplasms (MNs), the detection risk of which is higher than that in the population of respective age groups. The rate of MNs in PM/DM ranges from 9 to 50%. The relationship to MNs is described in each subtype of IIM; however, these are most common in DM. The patients suffering from PM/DM associated with MNs have a worse prognosis than those without MNs. The early detection of MNs could improve the prognosis in these patients. The investigations published identify demographic, clinical, and laboratory factors increasing MN detection risks in patients with PM/DM. Just the same, they all cover small patient groups; the findings are heterogeneous and not well convincing, which calls for a further larger-scale study of this problem.

Objective

Objective: to reveal and identify the specific features of paraneoplastic myositis (PnM).

Subjects and methods

Subjects and methods. The investigation included 320 patients with a valid diagnosis of IIM, who had been followed up in the period of 1996 to 2016. The patients underwent laboratory tests, manual proximal muscle strength testing using a 10-point scale and electromyographic examination with needle electrodes.

Results and discussion

Results and discussion. PnM was detected in 32 (10%) of the 320 patients with IIM. Among the patients with PnM, there were 6 (19%) men and 26 (81%) women. The mean age at the onset of PnM was 55.4 years. PnM manifested with characteristic musculocutaneous syndrome in 19 (59%) patients; 18 (41%) of them were found to have MNs within the first year after disease onset. The manifestation of MNs was preliminary to the picture of PM/DM in 13 (41%) patients. The most commonly detected conditions were ovarian cancer (37.5%), MNs of the lung and breast (15%); next were MNs of the intestine (12.5%), blood (6.3%), uterus (6%), and stomach (3.1%). The median survival was 5 years in patients with PnM.

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The authors declare that there are no conflicts of interest present.